Utilização de serviços odontológicos entre adolescentes: análise a partir de dois modelos teóricos

Abstract

The aim of this study was to analyze the use of dental services among adolescents based on two theoretical models. The first model sought to analyze contextual and individual characteristics associated with the non-use of dental services by adolescents participating in the 2019 National School Health Survey (PeNSE), based on Andersen's behavioral model. To this end, a cross-sectional study was conducted using multilevel Poisson regression models. Contextual characteristics such as the Municipal Human Development Index (MHDI) and safety in the school environment (PR = 0.96; CI = 0.92-0.99), coverage of oral health teams, ratio of dentists to population, and access to fluoridated water (PR = 0.95; CI = 0.92-0.99) were associated with a higher prevalence of having visited the dentist in the last year. In addition, among the capitals with the highest percentage of adolescents with poor self-rated health, there was a higher prevalence of not having visited the dentist (PR = 1.05; CI = 1.01-1.09). Psychosocial and family context factors, such as number of friends (OR = 0.85; CI = 0.79-0.92), self-assessment of body image (OR = 1.12; CI = 1.05-1.19), living with father and mother (OR = 0.95; CI = 0.93–0.98), supervision of leisure activities (PR = 0.91; CI = 0.85–0.97), and understanding of their concerns by caregivers (PR = 0.76; CI = 0.72–0.80) were related to the outcome. Female adolescents (PR = 0.85; CI = 0.83 - 0.88), white race/color, from private schools (PR = 0.61; CI = 0.59–0.63), with a greater number of household assets (PR = 0.87; CI = 0.86–0.88), and who reported dental pain (PR = 1.09; CI = 1.05–1.13) had a higher prevalence of dental visits. The second model sought to longitudinally examine the influence of the use of the sociodental approach on the use of dental services, oral health measures, and oral health-related quality of life (OHRLQ) among adolescents living in the eastern zone of the city of Manaus. Validated questionnaires were used to collect information on socioeconomic status, HRQoL, and health behaviors (sugar intake, toothbrushing frequency, regular use of fluoride toothpaste, and dental care patterns). Normative need was assessed according to decayed teeth, clinical consequences of untreated dental caries, malocclusion, trauma, and dental calculus. The relationships between variables were tested using structural equation modeling. The findings indicated that sociodental need directly predicted the use of dental services at the one-year follow-up. Use of dental services mediated the association between sociodental need and the incidence of dental caries and filled teeth. The worst HRQoL at follow-up was directly predicted by greater sociodental needs at the beginning of the study and fewer filled teeth at the one-year follow-up. Better socioeconomic status was directly associated with better health behaviors and indirectly related to the incidence of dental caries and filled teeth. Taken together, the findings point to the importance of dental service utilization as a health behavior related to sociodemographic, psychosocial, clinical, family, and contextual factors among adolescents. However, the potential benefits of this behavior alone in preventing dental caries and improving HRQoL were not confirmed.